| NPI | 1720301971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 17504) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 10921) |
| Enumeration Date | 2010-03-02 |
| Last Update Date | 2010-03-02 |