| NPI | 1942542550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 12590) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 151499) |
| Enumeration Date | 2013-03-21 |
| Last Update Date | 2013-03-21 |