| NPI | 1346526803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI R9925-040) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IA 15773) |
| Enumeration Date | 2011-10-28 |
| Last Update Date | 2011-10-28 |