| NPI | 1285797613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 14847) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT 8821) |
| 183500000X Pharmacist (Licence: VA 0202012816) | |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2007-07-08 |