| NPI | 1942337605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 5850206-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID p5941) |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2009-06-25 |