| NPI | 1164742318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP443633) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RPI001610) |
| Enumeration Date | 2010-06-09 |
| Last Update Date | 2012-01-11 |