| NPI | 1427327428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MN 120455) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 16503-40) |
| Enumeration Date | 2011-12-20 |
| Last Update Date | 2017-10-30 |