| NPI | 1578544235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 5513) |
| Additional Taxonomies | 225000000X Orthotic Fitter (Licence: NC CFts1099) |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2010-09-20 |