| NPI | 1528096104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ND 4845) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 117388-4) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2007-07-08 |