| NPI | 1407138548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NV 12157) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 025103) |
| Enumeration Date | 2011-09-14 |
| Last Update Date | 2011-09-14 |