| NPI | 1194034264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AR pd05554) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MS 5911) |
| Enumeration Date | 2010-10-06 |
| Last Update Date | 2010-10-06 |