| NPI | 1184139057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 26122) |
| Additional Taxonomies | 1835P2201X Pharmacist Ambulatory Care (Licence: NC 26122) |
| Enumeration Date | 2017-12-13 |
| Last Update Date | 2017-12-13 |