| NPI | 1164528477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MS T-09554) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 39763) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2007-07-08 |