| NPI | 1366818080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS47646) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: DC PH3314) |
| 183500000X Pharmacist (Licence: PA RP044100L) | |
| 183500000X Pharmacist (Licence: VA 0202208360) | |
| Enumeration Date | 2015-08-17 |
| Last Update Date | 2015-08-17 |