| NPI | 1215982558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TN 9371) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 12659) |
| 183500000X Pharmacist (Licence: VA 0202012710) | |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2007-07-08 |