| NPI | 1467701128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 22062) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202211711) |
| Enumeration Date | 2012-09-09 |
| Last Update Date | 2012-09-09 |