| NPI | 1083895270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 7900-040) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL P535285) |
| Enumeration Date | 2007-11-16 |
| Last Update Date | 2007-11-16 |