| NPI | 1780966564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 5724565-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 5724565-8911) |
| Enumeration Date | 2011-09-16 |
| Last Update Date | 2011-09-16 |