| NPI | 1346639069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 36951) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 1-12174) |
| Enumeration Date | 2015-01-19 |
| Last Update Date | 2015-01-19 |