| NPI | 1558498071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 17533) |
| Additional Taxonomies | 146M00000X Emergency Medical Technician, Intermediate (Licence: TX 31094) |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2007-10-12 |