| NPI | 1871723007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NV 15947) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 147533-1701) |
| Enumeration Date | 2009-07-22 |
| Last Update Date | 2009-07-22 |