| NPI | 1518248707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2009037261) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 1-14627) |
| Enumeration Date | 2011-09-01 |
| Last Update Date | 2011-09-01 |