| NPI | 1740478361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: IA 14746) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS 40074) |
| 183500000X Pharmacist (Licence: MO 043286) | |
| Enumeration Date | 2007-10-09 |
| Last Update Date | 2008-06-12 |