| NPI | 1679979371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WY 3647) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO 0020018) |
| Enumeration Date | 2014-11-07 |
| Last Update Date | 2019-05-30 |