| NPI | 1538100227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 5140587-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: LA 16831) |
| 183500000X Pharmacist (Licence: MS E-09140) | |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2011-01-06 |