| NPI | 1881764819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: LA 13938) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 33192) |
| 183500000X Pharmacist (Licence: CO 13255) | |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2007-07-08 |