| NPI | 1225351687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 10303) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC PH12508) |
| 183500000X Pharmacist (Licence: VA 0202005664) | |
| Enumeration Date | 2010-03-12 |
| Last Update Date | 2010-03-12 |