| NPI | 1568460004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202012130) |
| Additional Taxonomies | 1835P1300X Pharmacist, Psychiatric (Licence: VA 0202012130) |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2014-05-27 |