| NPI | 1346519535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP441196) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ S12221) |
| 183500000X Pharmacist (Licence: WV 7435) | |
| Enumeration Date | 2011-12-19 |
| Last Update Date | 2011-12-19 |