| NPI | 1104833342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 044769) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OK 12711) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2009-10-28 |