| NPI | 1043520125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 21344) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 12979) |
| Enumeration Date | 2010-10-07 |
| Last Update Date | 2011-01-14 |