| NPI | 1902105257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302029165) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 113523) |
| Enumeration Date | 2011-03-24 |
| Last Update Date | 2011-03-24 |