| NPI | 1811908361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OK 12894) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV 5316) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2007-07-08 |