| NPI | 1457655268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 17815) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP440837) |
| Enumeration Date | 2011-01-08 |
| Last Update Date | 2011-01-08 |