| NPI | 1154324556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA 19489) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP035829R) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2013-04-11 |