| NPI | 1447520614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 327425-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 18573) |
| 183500000X Pharmacist (Licence: CO 13655) | |
| Enumeration Date | 2012-01-05 |
| Last Update Date | 2012-01-05 |