| NPI | 1861709826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: LA 10370) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 37147) |
| Enumeration Date | 2010-09-10 |
| Last Update Date | 2010-09-10 |