| NPI | 1437428125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 17440) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VT 33-0003039) |
| 183500000X Pharmacist (Licence: CO 13105) | |
| 183500000X Pharmacist (Licence: NY 038095) | |
| Enumeration Date | 2011-12-25 |
| Last Update Date | 2012-03-06 |