| NPI | 1922336635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 09132) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH010769) |
| 183500000X Pharmacist (Licence: TN 0000031273) | |
| Enumeration Date | 2009-11-19 |
| Last Update Date | 2009-11-19 |