| NPI | 1497915375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA 23951) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NH 3155) |
| Enumeration Date | 2008-06-13 |
| Last Update Date | 2013-09-24 |