| NPI | 1386913804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 41689) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NM RP00006573) |
| 183500000X Pharmacist (Licence: AZ S019545) | |
| Enumeration Date | 2011-12-29 |
| Last Update Date | 2015-05-27 |