| NPI | 1174707681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AK 2007) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 4740953-1701) |
| 183500000X Pharmacist (Licence: ID P6491) | |
| Enumeration Date | 2007-12-19 |
| Last Update Date | 2012-02-15 |