| NPI | 1609182237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: IA 20857) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 46216) |
| Enumeration Date | 2010-08-20 |
| Last Update Date | 2010-08-20 |