| NPI | 1861788226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MN 122315) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 5404968-1701) |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2016-10-20 |