| NPI | 1669788535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 6217) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202205422) |
| Enumeration Date | 2010-08-29 |
| Last Update Date | 2012-05-10 |