| NPI | 1891084802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 13743) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 27410) |
| Enumeration Date | 2011-03-30 |
| Last Update Date | 2011-03-30 |