| NPI | 1366841256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 39946) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: TX 39946) |
| Enumeration Date | 2014-08-18 |
| Last Update Date | 2014-08-18 |