| NPI | 1649337007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PR 2500) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: PR 1287160001) |
| 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: PR 07-F0696) | |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2008-04-30 |