| NPI | 1699051300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP445496) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: DC PH1000001037) |
| 183500000X Pharmacist (Licence: MD 20115) | |
| Enumeration Date | 2011-10-26 |
| Last Update Date | 2012-02-23 |