| NPI | 1780091843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KS 1-13187) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 36320) |
| 183500000X Pharmacist (Licence: MO 20030018137) | |
| Enumeration Date | 2014-07-21 |
| Last Update Date | 2014-07-21 |