NPI | 1790055002 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS23961) |
Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH16054) |
183500000X Pharmacist (Licence: NH R0990) | |
Enumeration Date | 2012-01-03 |
Last Update Date | 2012-01-03 |