| NPI | 1487674131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 13230-040) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV 2683) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2007-07-08 |