| NPI | 1174595649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MN 115338-3) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ND 3947) |
| 183500000X Pharmacist (Licence: SD R4623) | |
| 183500000X Pharmacist (Licence: WI 16182-040) | |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2011-12-15 |