| NPI | 1285041731 |
|---|---|
| Other Name | N/A N/A N/A |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NM 00007746) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 51338) |
| Enumeration Date | 2014-07-16 |
| Last Update Date | 2014-07-16 |