| NPI | 1710215744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 38847) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: LA 17322) |
| Enumeration Date | 2009-12-02 |
| Last Update Date | 2009-12-02 |