| NPI | 1063748796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 46615) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OK 14307) |
| Enumeration Date | 2009-10-31 |
| Last Update Date | 2019-05-17 |