| NPI | 1639454341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 11868-40) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP029912L) |
| Enumeration Date | 2011-10-13 |
| Last Update Date | 2011-10-13 |