| NPI | 1295166627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2013038702) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 1-16135) |
| Enumeration Date | 2013-12-11 |
| Last Update Date | 2013-12-11 |