| NPI | 1801887492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NM RP00004227) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 006905) |
| 183500000X Pharmacist (Licence: WY 1894) | |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2007-07-08 |