| NPI | 1114159035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC 6176) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 9956) |
| Enumeration Date | 2009-08-11 |
| Last Update Date | 2009-08-11 |