| NPI | 1255681912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2012033292) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: MO 2012031289) |
| Enumeration Date | 2012-09-10 |
| Last Update Date | 2014-06-29 |