| NPI | 1174838247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: LA 10879) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 21972) |
| Enumeration Date | 2010-08-13 |
| Last Update Date | 2010-08-13 |