| NPI | 1407859457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302030831) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP032139L) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2017-04-04 |