| NPI | 1164644076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NH 2912) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 18129) |
| 183500000X Pharmacist (Licence: MA 22545) | |
| 183500000X Pharmacist (Licence: ME PR5283) | |
| 183500000X Pharmacist (Licence: FL PS 30414) | |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2007-07-08 |