| NPI | 1699073296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 18796) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 47072) |
| Enumeration Date | 2011-03-05 |
| Last Update Date | 2012-07-28 |