| NPI | 1699026559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 54167) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: LA 46160) |
| Enumeration Date | 2012-10-01 |
| Last Update Date | 2014-06-13 |