| NPI | 1578904611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MN 122198) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 53258) |
| 183500000X Pharmacist (Licence: SD 6058) | |
| Enumeration Date | 2013-07-16 |
| Last Update Date | 2015-06-02 |