| NPI | 1750695193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202209155) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS42542) |
| 183500000X Pharmacist (Licence: CO 18665) | |
| Enumeration Date | 2010-07-27 |
| Last Update Date | 2010-07-27 |