| NPI | 1568761112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ID P5067) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR 8121) |
| Enumeration Date | 2011-03-22 |
| Last Update Date | 2011-03-22 |