| NPI | 1932498557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR 6611) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH60060820) |
| 183500000X Pharmacist (Licence: AZ S017817) | |
| 183500000X Pharmacist (Licence: TX 24695) | |
| Enumeration Date | 2011-04-05 |
| Last Update Date | 2011-04-05 |