| NPI | 1982917530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 15895-40) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 21062) |
| Enumeration Date | 2010-07-23 |
| Last Update Date | 2010-07-23 |