| NPI | 1790012680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NV 11268) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR 9065) |
| Enumeration Date | 2009-11-12 |
| Last Update Date | 2009-11-12 |