| NPI | 1972855492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ 021644) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WY 3594) |
| 183500000X Pharmacist (Licence: CO 19726) | |
| 183500000X Pharmacist (Licence: SD 6102) | |
| 183500000X Pharmacist (Licence: NE 14342) | |
| Enumeration Date | 2012-10-08 |
| Last Update Date | 2016-12-02 |