| NPI | 1730100314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 44703) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 13655-040) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2012-01-30 |