| NPI | 1750652319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202209154) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03078900) |
| 183500000X Pharmacist (Licence: DC PH100000711) | |
| Enumeration Date | 2012-01-13 |
| Last Update Date | 2012-01-13 |