| NPI | 1407132764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MN 120573) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ND 5410) |
| Enumeration Date | 2011-10-31 |
| Last Update Date | 2011-10-31 |