| NPI | 1669824215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: LA 021574) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MS 14282) |
| 183500000X Pharmacist (Licence: TX 45985) | |
| 183500000X Pharmacist (Licence: MD 17309) | |
| Enumeration Date | 2016-07-07 |
| Last Update Date | 2016-07-07 |