| NPI | 1003139841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NE 8375) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WY 1875) |
| Enumeration Date | 2010-03-08 |
| Last Update Date | 2010-03-08 |