| NPI | 1336434943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: LA 16936) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AL 12549) |
| Enumeration Date | 2011-06-10 |
| Last Update Date | 2011-06-10 |