| NPI | 1518349711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL ps00015902) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 54846) |
| 183500000X Pharmacist (Licence: NY 27680) | |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2015-06-24 |