| NPI | 1568597763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 4842641-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WY 2877) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2011-09-06 |