| NPI | 1174976161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VT 033.0002869) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 7699207-1701) |
| Enumeration Date | 2016-07-14 |
| Last Update Date | 2016-07-14 |