| NPI | 1205015948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302034129) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 6637800-1701) |
| Enumeration Date | 2007-10-30 |
| Last Update Date | 2007-10-30 |