| NPI | 1043509631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ID P4096) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID CS2026) |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2011-04-04 |