| NPI | 1225309792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 22118) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP445961) |
| Enumeration Date | 2012-01-15 |
| Last Update Date | 2012-01-15 |