| NPI | 1275839805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MN 119889) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 17271) |
| Enumeration Date | 2011-01-29 |
| Last Update Date | 2011-01-29 |