| NPI | 1487653309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 36036) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ 6281) |
| 183500000X Pharmacist (Licence: CA 30557) | |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2007-07-08 |