| NPI | 1629359211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2005007843) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 49918) |
| Enumeration Date | 2011-09-09 |
| Last Update Date | 2012-10-16 |