| NPI | 1669655379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 050446) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH60185111) |
| 183500000X Pharmacist (Licence: OR 0013421) | |
| Enumeration Date | 2007-12-17 |
| Last Update Date | 2016-10-05 |