| NPI | 1023450129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ND 5559) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 121223) |
| Enumeration Date | 2013-07-18 |
| Last Update Date | 2013-07-29 |