| NPI | 1568520468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WY 3132) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 1-12284) |
| 183500000X Pharmacist (Licence: TX 355787) | |
| 183500000X Pharmacist (Licence: UT 3082899-1701) | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2018-04-17 |