| NPI | 1891245452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 18274) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 16408) |
| Enumeration Date | 2016-10-07 |
| Last Update Date | 2016-10-07 |