| NPI | 1255523361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 46547) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 17165) |
| Enumeration Date | 2007-08-13 |
| Last Update Date | 2011-11-30 |