| NPI | 1578534616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NM 4901) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ND 3538) |
| 183500000X Pharmacist (Licence: MN 117090-0) | |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2007-07-08 |