| NPI | 1124579313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 5039647-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WY 3916) |
| Enumeration Date | 2016-10-22 |
| Last Update Date | 2016-10-22 |