| NPI | 1891198768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302036923) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 19666) |
| 183500000X Pharmacist (Licence: TX 49599) | |
| 183500000X Pharmacist (Licence: DC PH100000799) | |
| Enumeration Date | 2014-10-06 |
| Last Update Date | 2014-10-06 |