| NPI | 1598974735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 15921) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 10282) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2008-06-11 |