| NPI | 1700184314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC 5739) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 7636) |
| Enumeration Date | 2011-03-06 |
| Last Update Date | 2011-03-06 |