| NPI | 1073866810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ME PR12740) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WY 3269) |
| Enumeration Date | 2012-10-17 |
| Last Update Date | 2013-10-28 |