| NPI | 1639627722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 70207) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 35110) |
| Enumeration Date | 2016-09-17 |
| Last Update Date | 2016-09-17 |