| NPI | 1770639049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 43876) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO PH 027959) |
| 183500000X Pharmacist (Licence: IN 26011910) | |
| 183500000X Pharmacist (Licence: MA 14889) | |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2007-07-08 |