| NPI | 1912140609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MN 118859) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ND 5120) |
| Enumeration Date | 2009-04-11 |
| Last Update Date | 2009-04-11 |