| NPI | 1376991554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CT 12709) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS51349) |
| Enumeration Date | 2016-05-29 |
| Last Update Date | 2016-05-29 |