| NPI | 1952687311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302039856) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TN 35548) |
| 183500000X Pharmacist (Licence: TX 56348) | |
| Enumeration Date | 2011-10-31 |
| Last Update Date | 2015-05-04 |