| NPI | 1700184769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC 7608) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 11184) |
| 183500000X Pharmacist (Licence: WV 3601) | |
| Enumeration Date | 2011-03-01 |
| Last Update Date | 2011-03-01 |