| NPI | 1104156314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 20071) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ S016295) |
| Enumeration Date | 2010-01-11 |
| Last Update Date | 2012-07-31 |