| NPI | 1083180756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA 040717) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL 40915) |
| Enumeration Date | 2018-10-19 |
| Last Update Date | 2018-10-19 |