| NPI | 1396055042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 5887548-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 5887548-8911) |
| Enumeration Date | 2010-10-15 |
| Last Update Date | 2013-03-25 |