| NPI | 1720386089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 17949) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 13903) |
| Enumeration Date | 2011-03-09 |
| Last Update Date | 2011-03-09 |