| NPI | 1104134493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: LA 15290) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS39450) |
| 183500000X Pharmacist (Licence: TX 42997) | |
| 183500000X Pharmacist (Licence: MS 09296) | |
| Enumeration Date | 2010-09-20 |
| Last Update Date | 2018-06-09 |