| NPI | 1366569501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: IA 16833) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 8272) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2007-07-08 |