| NPI | 1790052983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302034092) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH022406) |
| Enumeration Date | 2011-11-16 |
| Last Update Date | 2011-11-16 |