| NPI | 1962747436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR 7883) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI R8023) |
| Enumeration Date | 2012-12-10 |
| Last Update Date | 2012-12-10 |