| NPI | 1346589710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 51258) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302039206) |
| Enumeration Date | 2013-02-05 |
| Last Update Date | 2013-02-05 |