| NPI | 1851527634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 09837) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP0003512) |
| 183500000X Pharmacist (Licence: TN 11493) | |
| Enumeration Date | 2009-06-06 |
| Last Update Date | 2009-06-06 |