| NPI | 1265505051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 14517-040) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 17907) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2007-07-08 |