| NPI | 1265731848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MS T-010671) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 48331) |
| Enumeration Date | 2011-03-22 |
| Last Update Date | 2011-03-22 |