| NPI | 1104111723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 151839-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 10711) |
| Enumeration Date | 2011-06-10 |
| Last Update Date | 2011-06-10 |