| NPI | 1750677597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 20105) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP044868L) |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2011-06-20 |