| NPI | 1659634533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2008028091) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO 19125) |
| Enumeration Date | 2012-06-16 |
| Last Update Date | 2014-10-29 |