| NPI | 1609211895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS38620) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302034761) |
| Enumeration Date | 2013-05-01 |
| Last Update Date | 2013-05-01 |