| NPI | 1881693539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA 013063) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 27077) |
| Enumeration Date | 2005-07-15 |
| Last Update Date | 2011-01-25 |