| NPI | 1417394966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ID P5825) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR 0010516) |
| Enumeration Date | 2013-05-23 |
| Last Update Date | 2013-05-23 |