| NPI | 1295964336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 19375) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP443586) |
| Enumeration Date | 2009-07-10 |
| Last Update Date | 2012-07-13 |