| NPI | 1902146814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 42298) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ S012043) |
| 183500000X Pharmacist (Licence: CO 15286) | |
| Enumeration Date | 2013-03-01 |
| Last Update Date | 2013-03-01 |