| NPI | 1104177211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ SO14057) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AL 6699) |
| Enumeration Date | 2012-09-28 |
| Last Update Date | 2012-09-28 |