| NPI | 1104007848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MN 0118697) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: MN 0118697) |
| Enumeration Date | 2007-11-23 |
| Last Update Date | 2007-11-23 |