| NPI | 1679552178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202005700) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 12296040) |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2009-06-12 |