| NPI | 1194980656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA 17438) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OK 13752) |
| 183500000X Pharmacist (Licence: NH R0837) | |
| Enumeration Date | 2008-07-24 |
| Last Update Date | 2008-07-24 |