| NPI | 1861975914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 58829) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 1-106582) |
| Enumeration Date | 2018-09-13 |
| Last Update Date | 2018-09-13 |