| NPI | 1740203983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MN 114781-0) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 139886-1701) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2007-07-08 |