| NPI | 1164789855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 10884) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WY 2972) |
| 183500000X Pharmacist (Licence: CO 13237) | |
| 183500000X Pharmacist (Licence: ND 4063) | |
| 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: WI 10884) | |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2012-04-18 |