| NPI | 1386939239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: LA 011585) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MS T08421) |
| Enumeration Date | 2011-06-17 |
| Last Update Date | 2011-06-17 |