| NPI | 1508932534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 5125220-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID P5911) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2007-07-08 |