| NPI | 1730457995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 11040) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WY 2201) |
| Enumeration Date | 2011-12-02 |
| Last Update Date | 2011-12-02 |