| NPI | 1063713303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NE 13389) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 120182) |
| Enumeration Date | 2010-11-03 |
| Last Update Date | 2010-11-12 |