| NPI | 1922311349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: IA 21300) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 48608) |
| Enumeration Date | 2010-07-15 |
| Last Update Date | 2010-07-15 |