| NPI | 1750662482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC 12051) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 20924) |
| 183500000X Pharmacist (Licence: GA 25324) | |
| Enumeration Date | 2011-09-08 |
| Last Update Date | 2011-09-08 |