| NPI | 1902174527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MS E11713) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AL P16951) |
| Enumeration Date | 2011-12-09 |
| Last Update Date | 2016-04-01 |