| NPI | 1053523415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR 5668) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302038558) |
| Enumeration Date | 2007-05-05 |
| Last Update Date | 2011-06-08 |