| NPI | 1134115678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MT 5888) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA 41135) |
| 183500000X Pharmacist (Licence: NV 16649) | |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2008-03-02 |