| NPI | 1528315991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 52133) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 766259) |
| 183500000X Pharmacist (Licence: NE 13986) | |
| Enumeration Date | 2012-08-05 |
| Last Update Date | 2012-08-17 |