| NPI | 1295064459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NE 13487) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 45361) |
| Enumeration Date | 2009-12-17 |
| Last Update Date | 2013-03-19 |