| NPI | 1780811505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 13870) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: DC PH100000560) |
| Enumeration Date | 2009-06-18 |
| Last Update Date | 2009-06-18 |