| NPI | 1184988693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 51433) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NM RP00007871) |
| Enumeration Date | 2012-06-28 |
| Last Update Date | 2017-05-11 |