| NPI | 1316253651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 18823) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WY 3345) |
| Enumeration Date | 2010-08-24 |
| Last Update Date | 2010-08-24 |