| NPI | 1205109295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 14173) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IA 16668) |
| Enumeration Date | 2012-02-22 |
| Last Update Date | 2012-02-22 |