| NPI | 1396026621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL ps37125) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 013126) |
| 183500000X Pharmacist (Licence: MI 5302036721) | |
| Enumeration Date | 2011-08-31 |
| Last Update Date | 2011-08-31 |