| NPI | 1285034579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 21794) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP448499) |
| Enumeration Date | 2014-08-25 |
| Last Update Date | 2020-11-30 |