| NPI | 1215210208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: LA 18760) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MS T-010611) |
| Enumeration Date | 2011-09-26 |
| Last Update Date | 2015-08-27 |