| NPI | 1811283476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA 18376) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT 8623) |
| 183500000X Pharmacist (Licence: KS 1-14954) | |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2011-06-22 |