| NPI | 1023301884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WY 2897) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NE 11185) |
| Enumeration Date | 2011-05-25 |
| Last Update Date | 2011-05-25 |