| NPI | 1275817884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 040226) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IA R15327) |
| Enumeration Date | 2011-09-30 |
| Last Update Date | 2011-09-30 |