| NPI | 1881613404 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MT 3287) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 114448-6) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2007-07-08 |