| NPI | 1760777387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 47477) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AR PD11097) |
| Enumeration Date | 2011-06-10 |
| Last Update Date | 2011-11-17 |