| NPI | 1437174778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR 7600) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 28653) |
| 183500000X Pharmacist (Licence: NV 11385) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2007-07-08 |