| NPI | 1457638488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 044787) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 39738) |
| 183500000X Pharmacist (Licence: NM RP00006467) | |
| 183500000X Pharmacist (Licence: IA 16641) | |
| 183500000X Pharmacist (Licence: KS 1-12695) | |
| Enumeration Date | 2011-11-04 |
| Last Update Date | 2011-11-04 |