| NPI | 1265854103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2011023413) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 14112) |
| Enumeration Date | 2014-01-13 |
| Last Update Date | 2014-01-13 |