| NPI | 1629259007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 47108) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 1835P0018X Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: TX 47108) | |
| Enumeration Date | 2007-11-14 |
| Last Update Date | 2013-10-22 |