| NPI | 1194123059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MN 118441) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 14576) |
| Enumeration Date | 2014-12-09 |
| Last Update Date | 2014-12-09 |