| NPI | 1760742381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 6609601-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 6609601-8911) |
| 183500000X Pharmacist (Licence: MN 119522) | |
| Enumeration Date | 2012-05-17 |
| Last Update Date | 2012-05-17 |