| NPI | 1518235068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 6014320-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 48383) |
| Enumeration Date | 2011-12-12 |
| Last Update Date | 2014-08-29 |