| NPI | 1407881634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NM RP00006623) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 22618) |
| 183500000X Pharmacist (Licence: AZ 14479) | |
| 183500000X Pharmacist (Licence: PA RP439786) | |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2007-07-08 |