| NPI | 1922315571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 21281) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 15675-40) |
| Enumeration Date | 2010-09-02 |
| Last Update Date | 2010-09-02 |