| NPI | 1063746170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR 11689) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 33137) |
| Enumeration Date | 2009-09-22 |
| Last Update Date | 2009-09-22 |