| NPI | 1619290533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 19781) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO 10268) |
| Enumeration Date | 2010-03-05 |
| Last Update Date | 2010-03-05 |