| NPI | 1477996692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 18338) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 45444) |
| Enumeration Date | 2013-04-08 |
| Last Update Date | 2013-04-08 |