| NPI | 1124550371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2004034221) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 1-12912) |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2017-03-28 |