| NPI | 1851866560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 61902) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 2014041620) |
| Enumeration Date | 2018-10-09 |
| Last Update Date | 2018-10-09 |