| NPI | 1265716658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 52188521701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 12908) |
| Enumeration Date | 2011-10-04 |
| Last Update Date | 2011-10-04 |