| NPI | 1376823989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS40558) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH024259) |
| 183500000X Pharmacist (Licence: MI 5302035268) | |
| 183500000X Pharmacist (Licence: TX 47229) | |
| Enumeration Date | 2011-08-26 |
| Last Update Date | 2011-08-26 |