| NPI | 1861864563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL ps38275) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 8810078-1701) |
| Enumeration Date | 2015-10-21 |
| Last Update Date | 2015-10-21 |