| NPI | 1396833612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC 11163) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 17047) |
| 183500000X Pharmacist (Licence: GA 21351) | |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2007-07-08 |