| NPI | 1770805111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 13448-040) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ S013150) |
| Enumeration Date | 2010-02-26 |
| Last Update Date | 2010-02-26 |