| NPI | 1962781419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 16430-040) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 2010025222) |
| Enumeration Date | 2011-08-15 |
| Last Update Date | 2011-08-15 |