| NPI | 1669752200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NE 9065) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: HI PH3200) |
| 183500000X Pharmacist (Licence: CO PHA19050) | |
| Enumeration Date | 2011-08-26 |
| Last Update Date | 2011-08-26 |