| NPI | 1497036412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: LA 019279) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 49662) |
| Enumeration Date | 2011-09-03 |
| Last Update Date | 2011-09-03 |