| NPI | 1104106830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302036665) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI PS44595) |
| Enumeration Date | 2011-08-25 |
| Last Update Date | 2011-08-25 |