| NPI | 1538444682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 44699) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TN 27469) |
| Enumeration Date | 2011-10-19 |
| Last Update Date | 2011-10-19 |