| NPI | 1790237105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 47037) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ 13772) |
| 183500000X Pharmacist (Licence: OR 0011030) | |
| Enumeration Date | 2016-11-01 |
| Last Update Date | 2016-11-01 |