| NPI | 1235134826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ S018200) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH00010359) |
| 183500000X Pharmacist (Licence: TX 49642) | |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2012-02-22 |