| NPI | 1770708026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 19196) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IA 20386) |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2013-09-30 |