| NPI | 1275819781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ S020657) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO 15278) |
| 183500000X Pharmacist (Licence: NV 13565) | |
| Enumeration Date | 2011-10-28 |
| Last Update Date | 2015-03-28 |