| NPI | 1427278704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 38812) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH019172) |
| Enumeration Date | 2007-04-27 |
| Last Update Date | 2007-07-08 |