| NPI | 1124246715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NH R1461) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA 19797) |
| Enumeration Date | 2007-04-22 |
| Last Update Date | 2007-07-08 |