| NPI | 1407819279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2004006516) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IL 51031538) |
| 363AS0400X Physician Assistant, Surgical (Licence: MO 113956) | |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2007-07-08 |