| NPI | 1710073283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 333600000X Pharmacy (Licence: OK 13679) |
| Additional Taxonomies | 282NR1301X General Acute Care Hospital, Rural (Licence: OK 13679) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2012-01-11 |