| NPI | 1043592199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 47779) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 118553) |
| Enumeration Date | 2011-09-14 |
| Last Update Date | 2012-05-11 |