| NPI | 1417091901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202011893) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 14370) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2007-08-01 |