| NPI | 1184747669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 18583) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 5561430-1701) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2010-06-11 |