| NPI | 1386920478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 5483760-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 5483760-8911) |
| Enumeration Date | 2011-11-02 |
| Last Update Date | 2011-11-02 |