| NPI | 1508004912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MS E5783) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AL 13121) |
| Enumeration Date | 2009-01-23 |
| Last Update Date | 2009-01-23 |