| NPI | 1558655373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MN 119743) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 15682-40) |
| Enumeration Date | 2011-06-09 |
| Last Update Date | 2011-06-09 |