| NPI | 1326469073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NV 11991) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ S013999) |
| 183500000X Pharmacist (Licence: AL 15476) | |
| 183500000X Pharmacist (Licence: CO PHA0018961) | |
| Enumeration Date | 2013-12-25 |
| Last Update Date | 2013-12-25 |