| NPI | 1871612127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 18793) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202209614) |
| 183500000X Pharmacist (Licence: PA rp440398) | |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2010-03-14 |