| NPI | 1093090599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 14736) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TN 22988) |
| 183500000X Pharmacist (Licence: SC 9798) | |
| Enumeration Date | 2011-10-15 |
| Last Update Date | 2011-10-15 |