| NPI | 1801277744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 52101) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 8631761-1701) |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2015-06-16 |