| NPI | 1316367360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 36368) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: PA RP042726L) |
| Enumeration Date | 2014-04-17 |
| Last Update Date | 2014-04-17 |