| NPI | 1548562168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 18721) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 22766) |
| 183500000X Pharmacist (Licence: NM 3993) | |
| 183500000X Pharmacist (Licence: SC 11723) | |
| Enumeration Date | 2010-12-02 |
| Last Update Date | 2010-12-02 |