| NPI | 1508197484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MN 118473) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ 12204) |
| Enumeration Date | 2010-01-16 |
| Last Update Date | 2010-01-16 |