| NPI | 1215219746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302027482) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 014858) |
| Enumeration Date | 2011-09-10 |
| Last Update Date | 2011-09-10 |