| NPI | 1184907792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NE 11362) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IA 19432) |
| Enumeration Date | 2011-09-21 |
| Last Update Date | 2011-09-21 |