| NPI | 1639352693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MS T8267) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: LA 14921) |
| 183500000X Pharmacist (Licence: TX 32322) | |
| 183500000X Pharmacist (Licence: FL PS37247) | |
| Enumeration Date | 2007-12-13 |
| Last Update Date | 2007-12-13 |