| NPI | 1629138821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PU4205) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PH 16169) |
| 183500000X Pharmacist (Licence: NY 029651) | |
| 183500000X Pharmacist (Licence: CA 43141) | |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2007-07-08 |