| NPI | 1689996472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH00039805) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH23754) |
| 183500000X Pharmacist (Licence: TX 041389) | |
| Enumeration Date | 2010-02-19 |
| Last Update Date | 2010-02-19 |