| NPI | 1629355367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 044155) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 1-12438) |
| Enumeration Date | 2011-11-09 |
| Last Update Date | 2011-11-09 |