| NPI | 1114368222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 7293) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202211118) |
| Enumeration Date | 2013-07-17 |
| Last Update Date | 2013-07-17 |