| NPI | 1306280136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 34697) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 36530) |
| Enumeration Date | 2013-04-23 |
| Last Update Date | 2013-04-23 |