| NPI | 1598978165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MT 4474) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR 10117) |
| 183500000X Pharmacist (Licence: WA 50353) | |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2007-07-08 |