| NPI | 1427211481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0006588) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202206601) |
| 183500000X Pharmacist (Licence: SC 11588) | |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2008-07-09 |