| NPI | 1306858568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 282NC0060X General Acute Care Hospital, Critical Access (Licence: MO R5N37) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 28384) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2007-07-08 |