| NPI | 1699766865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ 15366) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MT 3925) |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2007-07-08 |