| NPI | 1801166319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MN 118542) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SD R5580) |
| Enumeration Date | 2012-01-01 |
| Last Update Date | 2012-01-01 |