| NPI | 1225306855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 7022112-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT 9436) |
| 183500000X Pharmacist (Licence: NV 17633) | |
| 183500000X Pharmacist (Licence: ID 6318) | |
| Enumeration Date | 2011-12-10 |
| Last Update Date | 2011-12-10 |