| NPI | 1649573809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC 13040) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 21652) |
| Enumeration Date | 2010-12-09 |
| Last Update Date | 2011-05-16 |