| NPI | 1649429838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA 019809) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-078020) |
| Enumeration Date | 2008-09-12 |
| Last Update Date | 2008-09-12 |