| NPI | 1275815086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: LA 18866) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH19477) |
| 183500000X Pharmacist (Licence: MS 09528) | |
| Enumeration Date | 2011-09-16 |
| Last Update Date | 2011-09-16 |