| NPI | 1669797544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TN 0000022033) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 44742) |
| Enumeration Date | 2010-04-02 |
| Last Update Date | 2013-03-28 |