| NPI | 1992066070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 041455) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 27680) |
| 183500000X Pharmacist (Licence: KS 1-15107) | |
| Enumeration Date | 2012-06-05 |
| Last Update Date | 2012-06-05 |