| NPI | 1104076801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SD R6251) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 119280) |
| 183500000X Pharmacist (Licence: NE 13130) | |
| 183500000X Pharmacist (Licence: IA 21318) | |
| Enumeration Date | 2008-09-30 |
| Last Update Date | 2015-04-22 |