| NPI | 1639483803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 17630) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: DE A1-0003742) |
| Enumeration Date | 2010-07-29 |
| Last Update Date | 2010-07-29 |