| NPI | 1285013334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NM RP00008307) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 55952) |
| Enumeration Date | 2015-05-22 |
| Last Update Date | 2015-05-22 |