| NPI | 1215196506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 50049) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NM RP00007009) |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2012-05-02 |