| NPI | 1861765497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP441212) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP1001810) |
| Enumeration Date | 2012-02-13 |
| Last Update Date | 2012-02-13 |