| NPI | 1982160107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MN 123688) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IA 23176) |
| Enumeration Date | 2019-02-12 |
| Last Update Date | 2019-02-12 |