| NPI | 1881238301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 41446) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 047003) |
| 183500000X Pharmacist (Licence: AZ S020608) | |
| Enumeration Date | 2019-10-29 |
| Last Update Date | 2019-10-29 |