| NPI | 1992255863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2000174736) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IA 17271) |
| Enumeration Date | 2016-10-04 |
| Last Update Date | 2016-10-04 |