| NPI | 1861899320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 55926) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NM RP00008292) |
| Enumeration Date | 2014-11-28 |
| Last Update Date | 2014-11-28 |