| NPI | 1982997268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 15356) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NM 5633) |
| 183500000X Pharmacist (Licence: AZ 17234) | |
| 183500000X Pharmacist (Licence: VA 7237) | |
| Enumeration Date | 2011-05-19 |
| Last Update Date | 2011-05-19 |