| NPI | 1275815797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302039037) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 040865) |
| 183500000X Pharmacist (Licence: KS 1-10442) | |
| Enumeration Date | 2011-09-10 |
| Last Update Date | 2011-09-10 |