| NPI | 1679542161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 35898-1) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NM RP-00004045) |
| 183500000X Pharmacist (Licence: UT 143808-1701) | |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2007-07-09 |