| NPI | 1558654632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NH R1211) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VT 0s3.0003630) |
| Enumeration Date | 2011-05-23 |
| Last Update Date | 2011-05-23 |