| NPI | 1669476636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 1266111701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302026145) |
| Enumeration Date | 2005-06-08 |
| Last Update Date | 2007-07-08 |