| NPI | 1114236502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 18454) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 18023) |
| Enumeration Date | 2010-10-01 |
| Last Update Date | 2010-10-01 |