| NPI | 1144689985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NV 17948) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 21492) |
| 183500000X Pharmacist (Licence: MA PH233737) | |
| Enumeration Date | 2016-02-22 |
| Last Update Date | 2016-02-22 |