| NPI | 1841242740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 30389) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 8246-040) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2008-03-14 |