| NPI | 1124469234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 16328) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 21865) |
| Enumeration Date | 2013-07-17 |
| Last Update Date | 2013-07-17 |