| NPI | 1881826451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 14164-040) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 17586) |
| Enumeration Date | 2009-08-17 |
| Last Update Date | 2009-08-18 |