| NPI | 1205125994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 010030) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202005302) |
| Enumeration Date | 2011-04-01 |
| Last Update Date | 2011-04-01 |