| NPI | 1053694562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WY 2696) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH008757) |
| Enumeration Date | 2011-09-21 |
| Last Update Date | 2011-09-21 |