| NPI | 1154621779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302036030) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 000219) |
| 183500000X Pharmacist (Licence: PA RP444523) | |
| Enumeration Date | 2010-10-29 |
| Last Update Date | 2010-10-29 |