| NPI | 1124364112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MN 115707) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302023815) |
| Enumeration Date | 2012-12-19 |
| Last Update Date | 2012-12-19 |