| NPI | 1588091722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 44810) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO 15973) |
| Enumeration Date | 2013-10-02 |
| Last Update Date | 2013-10-02 |