| NPI | 1053667774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ND 5247) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 119661) |
| Enumeration Date | 2012-07-31 |
| Last Update Date | 2012-07-31 |