| NPI | 1679842355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA 020181) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302031718) |
| Enumeration Date | 2011-12-23 |
| Last Update Date | 2011-12-23 |