| NPI | 1336413053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OK 10079) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 18676) |
| Enumeration Date | 2012-02-27 |
| Last Update Date | 2012-02-27 |