| NPI | 1346643921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AL 17688) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 50811) |
| 183500000X Pharmacist (Licence: VA 0202210213) | |
| Enumeration Date | 2014-09-26 |
| Last Update Date | 2014-09-26 |