| NPI | 1295067841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: IA 20725) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 118848) |
| Enumeration Date | 2010-02-08 |
| Last Update Date | 2012-07-11 |