| NPI | 1477560183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202207805) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: MI 5302036300) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2011-04-19 |