| NPI | 1528254307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 19157) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO 14430) |
| 183500000X Pharmacist (Licence: NV 15079) | |
| 183500000X Pharmacist (Licence: CA 53968) | |
| Enumeration Date | 2007-09-14 |
| Last Update Date | 2007-09-14 |