| NPI | 1487945234 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302040269) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 015247) |
| Enumeration Date | 2011-04-28 |
| Last Update Date | 2011-04-28 |