| NPI | 1912251752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OK 14999) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 50268) |
| Enumeration Date | 2012-11-01 |
| Last Update Date | 2012-11-01 |