| NPI | 1457637597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: RI rph04895) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH26539) |
| 183500000X Pharmacist (Licence: MI 5302035264) | |
| Enumeration Date | 2011-11-02 |
| Last Update Date | 2011-11-02 |