| NPI | 1851787972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MN 124390) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 17967-40) |
| Enumeration Date | 2015-04-15 |
| Last Update Date | 2020-09-18 |