| NPI | 1558400184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 6216012-8911) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 42455) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2007-08-01 |