| NPI | 1568613990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ 14019) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 16263) |
| 183500000X Pharmacist (Licence: NY 45295) | |
| Enumeration Date | 2008-10-03 |
| Last Update Date | 2013-12-30 |