| NPI | 1154741171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 24808) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC SC35420) |
| 183500000X Pharmacist (Licence: CO PHA.0020227) | |
| Enumeration Date | 2014-04-17 |
| Last Update Date | 2015-06-08 |