| NPI | 1124303250 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2007028067) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NE 13121) |
| Enumeration Date | 2011-10-20 |
| Last Update Date | 2011-10-20 |