| NPI | 1477839454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 47121) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: LA 019668) |
| Enumeration Date | 2011-10-23 |
| Last Update Date | 2012-09-12 |