| NPI | 1407282940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 017290) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 23704) |
| Enumeration Date | 2013-09-16 |
| Last Update Date | 2014-08-19 |