| NPI | 1053669259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302031493) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 41161) |
| 183500000X Pharmacist (Licence: FL PS57252) | |
| Enumeration Date | 2012-08-17 |
| Last Update Date | 2018-10-22 |