| NPI | 1679889570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA rp442250) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ME pr5192) |
| Enumeration Date | 2010-08-30 |
| Last Update Date | 2010-08-30 |