| NPI | 1235559881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR 0008601) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 47988) |
| 183500000X Pharmacist (Licence: NE 13142) | |
| 183500000X Pharmacist (Licence: AZ S015044) | |
| Enumeration Date | 2014-04-22 |
| Last Update Date | 2014-04-22 |