| NPI | 1245278183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 4593) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AK 4593) |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2011-10-11 |