| NPI | 1629454566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ID P5329) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR 7117) |
| 183500000X Pharmacist (Licence: CA 38474) | |
| 183500000X Pharmacist (Licence: AZ 8715) | |
| Enumeration Date | 2015-08-03 |
| Last Update Date | 2015-08-03 |