| NPI | 1720126709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: IA 19495) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO 15770) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2007-07-08 |