| NPI | 1346648268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TN 0000038748) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202213552) |
| 183500000X Pharmacist (Licence: NC 24684) | |
| 183500000X Pharmacist (Licence: KY 017462) | |
| Enumeration Date | 2014-12-09 |
| Last Update Date | 2014-12-09 |