| NPI | 1649348509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 22993) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 5661) |
| 183500000X Pharmacist (Licence: PA 29904) | |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2017-01-21 |