| NPI | 1316949001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: IA 18763) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 2004020353) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2007-07-08 |