| NPI | 1962878298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA RPH024559) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 51345) |
| Enumeration Date | 2015-08-21 |
| Last Update Date | 2015-08-21 |