| NPI | 1124361332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 9994) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 1-09276) |
| Enumeration Date | 2013-04-05 |
| Last Update Date | 2013-04-05 |