| NPI | 1003138546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NM RP00006710) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 4920123-1701) |
| 183500000X Pharmacist (Licence: NV 17569) | |
| Enumeration Date | 2010-02-25 |
| Last Update Date | 2010-02-25 |