| NPI | 1538252119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MN 111431) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: HI PH436) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2011-11-11 |