| NPI | 1679859771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MS 05504) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: LA 09698) |
| Enumeration Date | 2011-11-02 |
| Last Update Date | 2011-11-02 |