| NPI | 1700161858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 15174) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 6279) |
| Enumeration Date | 2011-10-19 |
| Last Update Date | 2011-10-19 |