| NPI | 1255749933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 20023) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA rp444225) |
| Enumeration Date | 2014-07-25 |
| Last Update Date | 2014-07-25 |