| NPI | 1114352184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 31267) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NM RP00005662) |
| Enumeration Date | 2013-09-10 |
| Last Update Date | 2013-09-10 |