| NPI | 1750460978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL FL9914PS009914) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA GA8290RPHO8290) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2007-07-08 |