| NPI | 1902212285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH 60459085) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03502200) |
| 183500000X Pharmacist (Licence: PA RP448543) | |
| 183500000X Pharmacist (Licence: MD 21067) | |
| 183500000X Pharmacist (Licence: DC PH100001327) | |
| Enumeration Date | 2014-07-07 |
| Last Update Date | 2014-07-07 |