| NPI | 1417179284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WY 3419) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO 16509) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2022-11-11 |