| NPI | 1023496056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NM RP00008351) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 56250) |
| Enumeration Date | 2015-05-11 |
| Last Update Date | 2015-05-11 |