| NPI | 1174808257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 14252-040) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ S015389) |
| 183500000X Pharmacist (Licence: CO PHA-16958) | |
| Enumeration Date | 2011-10-20 |
| Last Update Date | 2011-10-20 |