| NPI | 1073920625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 17019) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NM RP00007522) |
| Enumeration Date | 2014-07-15 |
| Last Update Date | 2014-07-15 |