| NPI | 1497732077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 045001) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 12612) |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2014-04-18 |