| NPI | 1083901763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WY 3450) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ S019113) |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2013-10-02 |