| NPI | 1508086463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ND 4957) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 118372) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2007-07-08 |