| NPI | 1740570670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 8076) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MS 9503) |
| Enumeration Date | 2011-04-12 |
| Last Update Date | 2011-04-12 |