| NPI | 1053681395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 15584-40) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SD 5724) |
| Enumeration Date | 2012-01-04 |
| Last Update Date | 2012-01-04 |