| NPI | 1760768147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MN 119629) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 15795-040) |
| Enumeration Date | 2011-10-28 |
| Last Update Date | 2011-10-28 |