| NPI | 1912395559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC 35868) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202213611) |
| Enumeration Date | 2015-01-06 |
| Last Update Date | 2015-01-06 |