| NPI | 1235481581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 25239) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH17698) |
| Enumeration Date | 2012-10-11 |
| Last Update Date | 2012-10-11 |