| NPI | 1346673969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA 60643249) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ME 27960) |
| 183500000X Pharmacist (Licence: TX 62553) | |
| 183500000X Pharmacist (Licence: NC 23730) | |
| Enumeration Date | 2013-08-19 |
| Last Update Date | 2021-11-19 |