| NPI | 1255617387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NE 11548) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 112174) |
| 183500000X Pharmacist (Licence: IA 19243) | |
| Enumeration Date | 2011-11-03 |
| Last Update Date | 2011-11-03 |