| NPI | 1891003950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NM RP00006346) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 20484) |
| Enumeration Date | 2010-09-22 |
| Last Update Date | 2017-02-20 |