| NPI | 1609917814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CT 5730) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA 17648) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2007-07-09 |