| NPI | 1063773000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC 13845) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC I-6655) |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2012-08-21 |