| NPI | 1750652202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ID P4590) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 9246-40) |
| Enumeration Date | 2012-01-14 |
| Last Update Date | 2012-01-14 |