| NPI | 1255674164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ID P6643) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID CS18944) |
| 183500000X Pharmacist (Licence: UT 6035703-1701) | |
| 183500000X Pharmacist (Licence: UT 6035703-8911) | |
| 183500000X Pharmacist (Licence: AZ S019112) | |
| Enumeration Date | 2013-03-28 |
| Last Update Date | 2013-03-28 |