| NPI | 1730402769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NE 13267) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IA 21255) |
| Enumeration Date | 2010-03-04 |
| Last Update Date | 2010-08-22 |