| NPI | 1588030811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 22152) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO 12152) |
| 183500000X Pharmacist (Licence: LA 017039) | |
| Enumeration Date | 2015-08-21 |
| Last Update Date | 2015-08-21 |