| NPI | 1184817553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MN 112302) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: MN 1060) |
| Enumeration Date | 2007-08-20 |
| Last Update Date | 2009-08-24 |