| NPI | 1053442681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 12268) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO 15893) |
| 183500000X Pharmacist (Licence: FL PS39753) | |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2007-07-08 |