| NPI | 1114251204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 36308) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OK 12111) |
| Enumeration Date | 2009-09-23 |
| Last Update Date | 2009-09-23 |