| NPI | 1215212188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: LA 18618) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202209559) |
| Enumeration Date | 2011-10-11 |
| Last Update Date | 2011-10-11 |