| NPI | 1487195269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 46009) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL 22240) |
| 183500000X Pharmacist (Licence: NY 36801) | |
| Enumeration Date | 2017-03-14 |
| Last Update Date | 2017-03-14 |