| NPI | 1104931195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA 15548) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 5429) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2007-07-08 |