| NPI | 1427323146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NV 17637) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO 18355) |
| 183500000X Pharmacist (Licence: WA ph 60196181) | |
| 183500000X Pharmacist (Licence: OR 12862) | |
| Enumeration Date | 2012-03-13 |
| Last Update Date | 2012-03-13 |