| NPI | 1477990323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 10429-40) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 112454) |
| 183500000X Pharmacist (Licence: ND 3433) | |
| Enumeration Date | 2013-06-02 |
| Last Update Date | 2013-06-02 |