| NPI | 1629391156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 27913) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 20910) |
| 183500000X Pharmacist (Licence: GA 017536) | |
| 183500000X Pharmacist (Licence: SC 9676) | |
| 183500000X Pharmacist (Licence: NM 6318) | |
| Enumeration Date | 2010-03-11 |
| Last Update Date | 2010-03-11 |