| NPI | 1780829184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 5088515-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 13171) |
| 183500000X Pharmacist (Licence: KY 012087) | |
| Enumeration Date | 2008-12-13 |
| Last Update Date | 2008-12-13 |