| NPI | 1831593730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 16773) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP042107L) |
| Enumeration Date | 2014-10-21 |
| Last Update Date | 2014-10-21 |