| NPI | 1407119530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NE 13897) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO PHA.0019750) |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2014-10-02 |