| NPI | 1861791642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AL 16033) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MS e06356) |
| Enumeration Date | 2011-03-20 |
| Last Update Date | 2011-03-20 |