| NPI | 1962734236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60190480) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 052683) |
| 183500000X Pharmacist (Licence: IL 051293452) | |
| Enumeration Date | 2010-02-11 |
| Last Update Date | 2014-07-16 |