| NPI | 1053383976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS0018908) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PU0003196) |
| 183500000X Pharmacist (Licence: NY 33093) | |
| 183500000X Pharmacist (Licence: NV 16787) | |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2009-04-06 |