| NPI | 1548543192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 7013110-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 17821) |
| Enumeration Date | 2011-09-20 |
| Last Update Date | 2011-09-20 |