| NPI | 1730409350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2009023457) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AL 16346) |
| Enumeration Date | 2010-06-04 |
| Last Update Date | 2010-06-04 |