| NPI | 1750742086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 48938) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ 10839) |
| Enumeration Date | 2016-03-15 |
| Last Update Date | 2016-03-15 |