| NPI | 1013284785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 16445) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 3083147) |
| Enumeration Date | 2011-11-23 |
| Last Update Date | 2011-11-23 |