| NPI | 1053869503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC 36848) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202214402) |
| Enumeration Date | 2016-09-13 |
| Last Update Date | 2016-09-18 |