| NPI | 1750380309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AL 12389) |
| Additional Taxonomies | 1835N0905X Pharmacist Nuclear (Licence: AL 12389) |
| Enumeration Date | 2005-07-16 |
| Last Update Date | 2007-07-08 |