| NPI | 1164704540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: IA 20060) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS34972) |
| Enumeration Date | 2011-09-12 |
| Last Update Date | 2011-09-30 |