| NPI | 1053697359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 13547) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 45822) |
| 183500000X Pharmacist (Licence: OR 11677) | |
| 183500000X Pharmacist (Licence: AZ SO17568) | |
| 183500000X Pharmacist (Licence: TX 47904) | |
| Enumeration Date | 2011-10-31 |
| Last Update Date | 2011-10-31 |