| NPI | 1538404199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC 6499) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA 019857) |
| Enumeration Date | 2012-12-06 |
| Last Update Date | 2012-12-06 |