| NPI | 1790992550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 16490) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 050699-1) |
| 183500000X Pharmacist (Licence: FL PS36461) | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2007-07-08 |