| NPI | 1215226816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NM RP00007564) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 19732) |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2011-04-04 |