| NPI | 1770863516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 21766) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202210648) |
| Enumeration Date | 2011-08-25 |
| Last Update Date | 2012-09-22 |