| NPI | 1154666931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL ps0034369) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 10108) |
| Enumeration Date | 2012-12-04 |
| Last Update Date | 2012-12-04 |