| NPI | 1093017014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC 011054) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202204712) |
| 183500000X Pharmacist (Licence: NC 16770) | |
| Enumeration Date | 2010-11-23 |
| Last Update Date | 2010-11-23 |