| NPI | 1386011872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA 26163) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT Pct 9706) |
| Enumeration Date | 2015-08-31 |
| Last Update Date | 2015-08-31 |