| NPI | 1174956221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH235136) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS50595) |
| Enumeration Date | 2013-08-13 |
| Last Update Date | 2014-08-06 |