| NPI | 1669548129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NH R0668) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA 16183) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2007-07-08 |