| NPI | 1780672766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 20524) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 15301) |
| 183500000X Pharmacist (Licence: CA 51630) | |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2012-01-20 |