| NPI | 1790055002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS23961) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH16054) |
| 183500000X Pharmacist (Licence: NH R0990) | |
| Enumeration Date | 2012-01-03 |
| Last Update Date | 2012-01-03 |