| NPI | 1265859060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 28643) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MS E7254) |
| Enumeration Date | 2014-03-18 |
| Last Update Date | 2014-03-18 |