| NPI | 1124303268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 52487) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NE 11801) |
| Enumeration Date | 2011-10-20 |
| Last Update Date | 2016-05-13 |