| NPI | 1063624369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OK 9379) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NM RP00004115) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2007-07-08 |