| NPI | 1619270667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202207606) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TN 0000029226) |
| 183500000X Pharmacist (Licence: KY 010639) | |
| 183500000X Pharmacist (Licence: FL PS 48332) | |
| Enumeration Date | 2010-12-14 |
| Last Update Date | 2011-10-24 |