| NPI | 1104190214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2011026612) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OK 14929) |
| Enumeration Date | 2012-03-07 |
| Last Update Date | 2012-03-07 |