| NPI | 1548435886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 9742040) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 117393) |
| Enumeration Date | 2008-04-28 |
| Last Update Date | 2008-04-28 |