| NPI | 1275743015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 273996-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID p5295) |
| 183500000X Pharmacist (Licence: WI 13994) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2007-07-08 |