| NPI | 1013293521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NE 9802) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IA 16311) |
| Enumeration Date | 2011-10-28 |
| Last Update Date | 2011-10-28 |