| NPI | 1669507299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MN 119580) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 16433) |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2010-02-11 |