| NPI | 1568695096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NM RP00007231) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 36216) |
| Enumeration Date | 2009-09-01 |
| Last Update Date | 2009-09-01 |