| NPI | 1376837658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 18471) |
| Additional Taxonomies | 1835P2201X Pharmacist, Ambulatory Care (Licence: MD 18471) |
| Enumeration Date | 2011-06-04 |
| Last Update Date | 2016-06-23 |