| NPI | 1306130364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 14490) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA rp044556t) |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2011-06-07 |