| NPI | 1043597925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ S019603) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 1-15603) |
| 183500000X Pharmacist (Licence: TX 52574) | |
| Enumeration Date | 2011-11-07 |
| Last Update Date | 2013-05-09 |