| NPI | 1184976649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 22175) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA 19055) |
| 183500000X Pharmacist (Licence: NH r1905) | |
| Enumeration Date | 2012-10-09 |
| Last Update Date | 2012-10-09 |