| NPI | 1164611414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 28871) |
| Additional Taxonomies | 1835P1200X Pharmacist Pharmacotherapy (Licence: TX 28871) |
| Enumeration Date | 2007-10-22 |
| Last Update Date | 2007-10-22 |