| NPI | 1669473534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AL 9262) |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: AL 106701) |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2013-07-31 |