| NPI | 1538454053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 15339) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 5302027045) |
| Enumeration Date | 2011-06-13 |
| Last Update Date | 2011-06-13 |