| NPI | 1770824682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WY 3194) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NM RP00003710) |
| Enumeration Date | 2013-03-04 |
| Last Update Date | 2013-03-04 |