| NPI | 1871891010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 19708) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS47308) |
| 183500000X Pharmacist (Licence: SC 12199) | |
| Enumeration Date | 2011-03-12 |
| Last Update Date | 2011-03-16 |