| NPI | 1386642411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OK 10143) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 23970) |
| 183500000X Pharmacist (Licence: AR 8784) | |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2008-02-07 |