| NPI | 1699005702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ID P5750) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH00069808) |
| 183500000X Pharmacist (Licence: AZ 11697) | |
| 183500000X Pharmacist (Licence: MT 6611) | |
| 183500000X Pharmacist (Licence: NV 13687) | |
| Enumeration Date | 2010-01-12 |
| Last Update Date | 2010-01-12 |