| NPI | 1679843262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0007318) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS45892) |
| Enumeration Date | 2012-01-12 |
| Last Update Date | 2012-01-12 |