| NPI | 1669765343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 6072986-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 15367) |
| 183500000X Pharmacist (Licence: TX 26803) | |
| Enumeration Date | 2011-05-27 |
| Last Update Date | 2011-05-27 |