| NPI | 1144587916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 11260) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 114698) |
| 183500000X Pharmacist (Licence: SD R5819) | |
| 183500000X Pharmacist (Licence: ND 5357) | |
| 183500000X Pharmacist (Licence: IA 21386) | |
| 183500000X Pharmacist (Licence: NE 13590) | |
| 183500000X Pharmacist (Licence: WY 3431) | |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2012-04-18 |