| NPI | 1669457586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 17478) |
| Additional Taxonomies | 1835N0905X Pharmacist Nuclear (Licence: NC 17478) |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2007-07-08 |