| NPI | 1073841987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 44854) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID P5753) |
| Enumeration Date | 2009-12-04 |
| Last Update Date | 2009-12-04 |