| NPI | 1700122488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NM NM-6165) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX Rph-38875) |
| Enumeration Date | 2012-12-27 |
| Last Update Date | 2012-12-27 |