| NPI | 1457385569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 40858) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 10467) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2007-07-08 |