| NPI | 1861972978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 62605) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH239460) |
| Enumeration Date | 2018-08-17 |
| Last Update Date | 2020-10-30 |