| NPI | 1336552611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202209160) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: DC 100001487) |
| 183500000X Pharmacist (Licence: NC 23775) | |
| Enumeration Date | 2014-06-04 |
| Last Update Date | 2014-06-04 |