| NPI | 1609049808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 22297) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 18324) |
| Enumeration Date | 2008-04-08 |
| Last Update Date | 2014-04-16 |