| NPI | 1316261613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 21556) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AK 892) |
| 183500000X Pharmacist (Licence: OR 7471) | |
| Enumeration Date | 2010-03-16 |
| Last Update Date | 2010-03-16 |