| NPI | 1033241724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH14571) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS45620) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2010-06-20 |