| NPI | 1629390448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC 12695) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 20712) |
| Enumeration Date | 2010-02-21 |
| Last Update Date | 2010-02-21 |