| NPI | 1922354646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL 36876) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 20205) |
| 183500000X Pharmacist (Licence: NM 00007220) | |
| Enumeration Date | 2012-07-31 |
| Last Update Date | 2012-07-31 |