| NPI | 1275884496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA 20999) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS50379) |
| 183500000X Pharmacist (Licence: CT 7926) | |
| Enumeration Date | 2012-09-27 |
| Last Update Date | 2014-07-29 |