| NPI | 1871875443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MN 120217) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO 18867) |
| Enumeration Date | 2011-09-09 |
| Last Update Date | 2016-07-08 |