| NPI | 1134431646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 16959) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH232478) |
| Enumeration Date | 2010-07-13 |
| Last Update Date | 2010-07-13 |