| NPI | 1013202175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: IA 21334) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 120065) |
| Enumeration Date | 2011-06-16 |
| Last Update Date | 2011-06-16 |