| NPI | 1780009449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 49047) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NM RP7472) |
| Enumeration Date | 2014-03-04 |
| Last Update Date | 2014-03-04 |