| NPI | 1124275383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WY 3605) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID P6205) |
| 183500000X Pharmacist (Licence: OR RPH-0012033) | |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2012-12-21 |