| NPI | 1629102777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL 34615) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PR 4795) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2013-01-15 |