| NPI | 1528425832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 57675) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202212335) |
| 183500000X Pharmacist (Licence: PA RP448553) | |
| Enumeration Date | 2016-01-19 |
| Last Update Date | 2016-01-19 |