| NPI | 1770850430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 18560) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AL 12377) |
| 183500000X Pharmacist (Licence: LA 14256) | |
| 183500000X Pharmacist (Licence: FL 26302) | |
| Enumeration Date | 2011-11-23 |
| Last Update Date | 2011-11-23 |