| NPI | 1376813055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 13915) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT 4995) |
| Enumeration Date | 2012-01-11 |
| Last Update Date | 2012-01-11 |