| NPI | 1790135416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC 36370) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IA 22044) |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2016-11-19 |