| NPI | 1578936605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 29569) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL 21561) |
| Enumeration Date | 2015-11-11 |
| Last Update Date | 2015-11-11 |