| NPI | 1558462853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TN 9252) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS 28731) |
| 183500000X Pharmacist (Licence: NE 12154) | |
| 183500000X Pharmacist (Licence: KY 13253) | |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2007-07-08 |