| NPI | 1396881686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 31334) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OK 13762) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2013-07-30 |