| NPI | 1093847626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ 9297) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA ph00011083) |
| 183500000X Pharmacist (Licence: IL 051.028783) | |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2007-07-08 |