NPI | 1124558119 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301113057) |
Additional Taxonomies | 333600000X Pharmacy (Licence: MI 5315086950) |
Enumeration Date | 2017-06-13 |
Last Update Date | 2017-06-13 |