| NPI | 1184794737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 13771) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP437364) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2007-07-08 |