| NPI | 1194072199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 266413-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 8001) |
| Enumeration Date | 2012-08-08 |
| Last Update Date | 2012-08-08 |