| NPI | 1194119529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SD R5906) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ND RPh4722) |
| 183500000X Pharmacist (Licence: KY 017476) | |
| Enumeration Date | 2015-03-24 |
| Last Update Date | 2015-03-24 |