| NPI | 1164799045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 11496-40) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ S021597) |
| Enumeration Date | 2011-11-21 |
| Last Update Date | 2016-07-28 |