| NPI | 1568745339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 47086) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS44276) |
| Enumeration Date | 2011-09-27 |
| Last Update Date | 2011-09-27 |