| NPI | 1477741726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 173000000X Legal Medicine (Licence: HI 11859) |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site (Licence: HI 11859) |
| Enumeration Date | 2007-10-11 |
| Last Update Date | 2017-11-03 |