| NPI | 1902187529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH23892) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 14477) |
| Enumeration Date | 2011-09-09 |
| Last Update Date | 2011-09-09 |