| NPI | 1902102791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP444376) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 20693) |
| Enumeration Date | 2011-01-27 |
| Last Update Date | 2011-01-27 |