| NPI | 1740561026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2008016514) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 1-14745) |
| Enumeration Date | 2011-08-31 |
| Last Update Date | 2011-08-31 |