| NPI | 1205858511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 11132 - 040) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IA 15100) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2007-07-08 |