| NPI | 1073790069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 18762) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 2003001219) |
| Enumeration Date | 2008-01-22 |
| Last Update Date | 2008-01-22 |