| NPI | 1639388168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 5725931-8911) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 16444) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2007-07-08 |