| NPI | 1609184670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WY 3303) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 3087010-1701) |
| Enumeration Date | 2010-09-23 |
| Last Update Date | 2010-09-23 |