| NPI | 1356851190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 17133) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS35969) |
| Enumeration Date | 2017-10-06 |
| Last Update Date | 2017-10-06 |