| NPI | 1629306493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 45964) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202205726) |
| 183500000X Pharmacist (Licence: NC 16990) | |
| Enumeration Date | 2009-12-06 |
| Last Update Date | 2014-02-28 |