| NPI | 1255709846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 15152) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OK 8952) |
| 183500000X Pharmacist (Licence: TX 22093) | |
| 183500000X Pharmacist (Licence: AZ 12876) | |
| Enumeration Date | 2015-09-13 |
| Last Update Date | 2015-09-13 |