| NPI | 1679823959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NH 3258) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH24421) |
| Enumeration Date | 2012-09-14 |
| Last Update Date | 2012-09-14 |