| NPI | 1578832234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 49217) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 2011037528) |
| 183500000X Pharmacist (Licence: KS 1-15621) | |
| Enumeration Date | 2011-12-23 |
| Last Update Date | 2011-12-23 |