| NPI | 1366798654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 6646682-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 6646682-8911) |
| Enumeration Date | 2012-07-24 |
| Last Update Date | 2012-07-24 |