| NPI | 1578858478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 49683) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 17927) |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2011-06-20 |