| NPI | 1285077222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 16956) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 009822) |
| Enumeration Date | 2013-04-09 |
| Last Update Date | 2013-04-09 |