| NPI | 1063821635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 16695) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 10571) |
| Enumeration Date | 2014-08-08 |
| Last Update Date | 2014-08-08 |