| NPI | 1891062410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ 14932) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO 17676) |
| Enumeration Date | 2011-11-28 |
| Last Update Date | 2011-11-28 |