| NPI | 1043573587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 60372) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03193300) |
| 183500000X Pharmacist (Licence: TX 49194) | |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2012-06-20 |