| NPI | 1508118647 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO PHA0019690) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP437691) |
| Enumeration Date | 2012-10-14 |
| Last Update Date | 2013-01-04 |