| NPI | 1932466497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 044666) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IA 15669) |
| 183500000X Pharmacist (Licence: KS 1-13449) | |
| Enumeration Date | 2012-04-20 |
| Last Update Date | 2012-04-20 |