| NPI | 1174711592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 14786) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 050151) |
| 183500000X Pharmacist (Licence: OR 10407) | |
| Enumeration Date | 2007-10-10 |
| Last Update Date | 2007-10-10 |