| NPI | 1003030255 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VT 3124) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NH 2720) |
| 183500000X Pharmacist (Licence: MD 12566) | |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2007-07-08 |