| NPI | 1063792588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 14890-40) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 118287) |
| Enumeration Date | 2011-08-29 |
| Last Update Date | 2011-08-29 |