| NPI | 1861048019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 29888) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP442888) |
| Enumeration Date | 2019-08-14 |
| Last Update Date | 2019-08-14 |