| NPI | 1083999676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 029516) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ s018727) |
| 183500000X Pharmacist (Licence: TX 58060) | |
| 183500000X Pharmacist (Licence: IL 051-031888) | |
| Enumeration Date | 2011-10-15 |
| Last Update Date | 2011-10-15 |