| NPI | 1205375011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 23744) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202212187) |
| Enumeration Date | 2017-02-14 |
| Last Update Date | 2017-02-14 |