| NPI | 1225582760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 26444) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 36767) |
| Enumeration Date | 2016-08-13 |
| Last Update Date | 2017-03-01 |