| NPI | 1558648915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 20589) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH233484) |
| 183500000X Pharmacist (Licence: NH 3743) | |
| Enumeration Date | 2011-11-12 |
| Last Update Date | 2014-05-15 |