| NPI | 1437339611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 12402-040) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 116685) |
| 1835P2201X Pharmacist, Ambulatory Care (Licence: CO PHA0019012) | |
| Enumeration Date | 2007-11-06 |
| Last Update Date | 2016-02-26 |