| NPI | 1790082816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 14449) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA rp042267l) |
| Enumeration Date | 2011-02-25 |
| Last Update Date | 2011-02-25 |