| NPI | 1205164423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 46943) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302033413) |
| Enumeration Date | 2009-11-29 |
| Last Update Date | 2009-11-29 |