| NPI | 1568739647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH26272) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 39806) |
| Enumeration Date | 2011-11-17 |
| Last Update Date | 2011-11-17 |