| NPI | 1205185071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH24015) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202205126) |
| Enumeration Date | 2012-09-07 |
| Last Update Date | 2013-04-30 |