| NPI | 1811984693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MT 2935) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WY 2371) |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2007-07-08 |