| NPI | 1497944995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 151322-1719) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 12971) |
| Enumeration Date | 2007-10-19 |
| Last Update Date | 2007-10-19 |