| NPI | 1467702134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 18753) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NM RP7554) |
| Enumeration Date | 2012-09-10 |
| Last Update Date | 2013-12-07 |