| NPI | 1922407600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 8088047-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 8088047-8911) |
| Enumeration Date | 2014-08-18 |
| Last Update Date | 2014-08-18 |