| NPI | 1316011471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 12372-040) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 115358-7) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2007-07-08 |