| NPI | 1821125527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS38664) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA 23049) |
| 183500000X Pharmacist (Licence: VT 033-0003309) | |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2007-07-08 |