| NPI | 1043628928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 9048650-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 017073) |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2014-07-23 |