| NPI | 1205077468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 8302028956) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 12894) |
| Enumeration Date | 2009-03-18 |
| Last Update Date | 2009-03-18 |