| NPI | 1265421242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NH R2055) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA ph2736) |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2014-09-10 |