| NPI | 1356698369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 19740) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 2012015610) |
| Enumeration Date | 2012-08-08 |
| Last Update Date | 2014-06-25 |