| NPI | 1295061943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CT 7214) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 46129) |
| Enumeration Date | 2009-10-29 |
| Last Update Date | 2009-10-29 |