| NPI | 1003126988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 6728592-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP445198) |
| Enumeration Date | 2010-10-13 |
| Last Update Date | 2013-07-23 |