| NPI | 1831219583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 15733) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 14873) |
| 183500000X Pharmacist (Licence: NV 13822) | |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2007-07-08 |