| NPI | 1225320153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WY 2689) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO 14217) |
| Enumeration Date | 2011-05-11 |
| Last Update Date | 2011-05-11 |