| NPI | 1215156377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NM 5227) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 43772) |
| 183500000X Pharmacist (Licence: MA 21034) | |
| 183500000X Pharmacist (Licence: NH 2662) | |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2007-07-08 |