| NPI | 1972910560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 07850) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP026391L) |
| Enumeration Date | 2014-07-16 |
| Last Update Date | 2014-07-16 |