| NPI | 1457511370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: TX 16854) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 31400) |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2008-06-13 |
| Last Update Date | 2010-05-06 |