| NPI | 1891072617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 20201) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 13678) |
| Enumeration Date | 2011-11-08 |
| Last Update Date | 2011-11-08 |