| NPI | 1295715928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302410858) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA 00056824) |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2007-07-08 |