| NPI | 1295881142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 18422) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 24063) |
| 183500000X Pharmacist (Licence: TX 19069) | |
| 183700000X Pharmacy Technician (Licence: TX 118736) | |
| 183700000X Pharmacy Technician (Licence: TX 118700) | |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2007-07-08 |