| NPI | 1891833471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NV 09783) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 35426) |
| 183500000X Pharmacist (Licence: TX 25353) | |
| Enumeration Date | 2007-02-03 |
| Last Update Date | 2007-07-08 |