| NPI | 1366819245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 23116) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH234198) |
| Enumeration Date | 2015-08-27 |
| Last Update Date | 2015-08-27 |