| NPI | 1639321037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 14179) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TN 33500) |
| 183500000X Pharmacist (Licence: SC 12801) | |
| Enumeration Date | 2008-10-16 |
| Last Update Date | 2012-10-25 |