| NPI | 1720208929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 18305) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NM rp00007253) |
| Enumeration Date | 2007-04-27 |
| Last Update Date | 2011-11-29 |