| NPI | 1194001206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MN 113401) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 9957040) |
| Enumeration Date | 2011-11-02 |
| Last Update Date | 2011-11-02 |