| NPI | 1790073070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 07372) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202006146) |
| 183500000X Pharmacist (Licence: SC 5538) | |
| Enumeration Date | 2011-07-20 |
| Last Update Date | 2011-07-20 |