| NPI | 1770867624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR 8046) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ S05462) |
| Enumeration Date | 2011-10-10 |
| Last Update Date | 2011-10-10 |