| NPI | 1295178812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 7052082-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO 10993) |
| Enumeration Date | 2013-04-12 |
| Last Update Date | 2013-04-12 |