| NPI | 1679983217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2013042221) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 1-16105) |
| Enumeration Date | 2014-05-05 |
| Last Update Date | 2014-05-05 |