| NPI | 1972594653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NM RP00006675) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: NM PC00000116) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2007-07-08 |