| NPI | 1619149499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 4550841-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 4550841-8911) |
| 183500000X Pharmacist (Licence: ID P5599) | |
| Enumeration Date | 2008-04-01 |
| Last Update Date | 2008-04-01 |