| NPI | 1598804940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: IA 14506) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NM RP00005961) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2008-08-12 |