| NPI | 1083755136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 007709) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 21401) |
| Enumeration Date | 2007-02-10 |
| Last Update Date | 2007-07-08 |