| NPI | 1174804884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC 10009) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 11297) |
| Enumeration Date | 2011-09-08 |
| Last Update Date | 2011-09-14 |