| NPI | 1326596537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: IA 18093) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 115616) |
| 183500000X Pharmacist (Licence: SD 4814) | |
| Enumeration Date | 2016-09-15 |
| Last Update Date | 2016-09-15 |