| NPI | 1477832491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 21806) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 015401) |
| Enumeration Date | 2011-08-08 |
| Last Update Date | 2011-08-08 |