| NPI | 1134414758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 56467) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 051446-1) |
| Enumeration Date | 2011-06-11 |
| Last Update Date | 2020-01-28 |