| NPI | 1629030564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MS T09885) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202205298) |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2007-07-08 |