| NPI | 1770815474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 17911) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NE 10807) |
| 183500000X Pharmacist (Licence: MN 116283) | |
| 183500000X Pharmacist (Licence: IA 18321) | |
| Enumeration Date | 2010-02-04 |
| Last Update Date | 2010-02-04 |