| NPI | 1891116224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 54177) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS49675) |
| Enumeration Date | 2014-01-03 |
| Last Update Date | 2014-01-03 |