| NPI | 1538433149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ S013758) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 15845) |
| Enumeration Date | 2012-02-28 |
| Last Update Date | 2012-02-28 |