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 |