| NPI | 1164768909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ S019590) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: LA 15070) |
| 183500000X Pharmacist (Licence: MD 17473) | |
| Enumeration Date | 2012-12-26 |
| Last Update Date | 2012-12-26 |