| NPI | 1336220953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 13879) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 11979) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2014-07-09 |