| NPI | 1568762367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 16762) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WY 33339) |
| Enumeration Date | 2010-10-26 |
| Last Update Date | 2010-10-26 |