| NPI | 1407263031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NM RP00008233) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: NV PT04927) |
| 183500000X Pharmacist (Licence: NV 18762) | |
| 183500000X Pharmacist (Licence: WA PH60465352) | |
| 183500000X Pharmacist (Licence: OR RPH-0014499) | |
| Enumeration Date | 2014-07-15 |
| Last Update Date | 2015-10-13 |