| NPI | 1366700619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 19358) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SD R5822) |
| 183500000X Pharmacist (Licence: MI 5302038124) | |
| Enumeration Date | 2012-04-24 |
| Last Update Date | 2012-04-24 |