| NPI | 1184640468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 14350-040) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 14987) |
| 183500000X Pharmacist (Licence: NC 15370) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2007-07-08 |