| NPI | 1891079299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: LA 010556) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ 015740) |
| 183500000X Pharmacist (Licence: AL 16229) | |
| Enumeration Date | 2011-10-04 |
| Last Update Date | 2011-10-04 |