| NPI | 1205055316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ S005675) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ 5675) |
| 183500000X Pharmacist (Licence: TX 26055) | |
| 183500000X Pharmacist (Licence: NM RP00003912) | |
| 1835G0303X Pharmacist Geriatric (Licence: NM RP00003912) | |
| 1835G0303X Pharmacist Geriatric (Licence: TX 26055) | |
| 1835G0303X Pharmacist Geriatric (Licence: AZ 5675) | |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2013-08-29 |