| NPI | 1205142759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS38537) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ S004529) |
| 183500000X Pharmacist (Licence: CA 25102) | |
| Enumeration Date | 2010-08-22 |
| Last Update Date | 2010-08-22 |