| NPI | 1962005686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS61958) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA Ph237483) |
| Enumeration Date | 2020-11-17 |
| Last Update Date | 2021-02-03 |