| NPI | 1306113394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 06854) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 007470) |
| 183500000X Pharmacist (Licence: AL 14656) | |
| Enumeration Date | 2011-11-19 |
| Last Update Date | 2011-11-19 |