| NPI | 1558631333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202206659) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NH 3417) |
| Enumeration Date | 2012-01-10 |
| Last Update Date | 2012-01-10 |