| NPI | 1023390234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA RPH027405) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH233352) |
| Enumeration Date | 2011-09-13 |
| Last Update Date | 2014-04-17 |