| NPI | 1215250840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 16392) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS 26488) |
| Enumeration Date | 2010-03-10 |
| Last Update Date | 2010-03-10 |