| NPI | 1245483338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MT 2993) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO 11272) |
| 183500000X Pharmacist (Licence: IA 13837) | |
| Enumeration Date | 2008-11-03 |
| Last Update Date | 2008-11-03 |