| NPI | 1316389620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 23687) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302043252) |
| Enumeration Date | 2013-07-28 |
| Last Update Date | 2016-04-27 |