| NPI | 1154603066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 5816944-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS47314) |
| 183500000X Pharmacist (Licence: CA 65309) | |
| Enumeration Date | 2011-09-16 |
| Last Update Date | 2011-09-16 |