| NPI | 1962835363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 63799) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 1-15795) |
| Enumeration Date | 2013-08-21 |
| Last Update Date | 2020-08-19 |