| NPI | 1245508464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 16154-040) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 2007026076) |
| Enumeration Date | 2011-12-02 |
| Last Update Date | 2011-12-02 |