| NPI | 1669539912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 57487) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ 9355) |
| 183500000X Pharmacist (Licence: CA 46931) | |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2016-10-03 |