| NPI | 1609178458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NV 017631) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR 0011837) |
| 183500000X Pharmacist (Licence: CA 64139) | |
| Enumeration Date | 2010-11-30 |
| Last Update Date | 2010-11-30 |