| NPI | 1336497767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AL 17830) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 22768) |
| 183500000X Pharmacist (Licence: FL PS49774) | |
| Enumeration Date | 2012-08-15 |
| Last Update Date | 2014-11-10 |