| NPI | 1588974059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NM RP00006755) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ S005272) |
| Enumeration Date | 2010-10-18 |
| Last Update Date | 2010-10-18 |