| NPI | 1558708131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 14450) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ S010569) |
| Enumeration Date | 2013-05-23 |
| Last Update Date | 2014-02-13 |