| NPI | 1497819403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 44052) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP044981L) |
| 183500000X Pharmacist (Licence: VA 0202205517) | |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2007-07-08 |