| NPI | 1386058634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 21596) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: DC PH100001476) |
| Enumeration Date | 2014-06-15 |
| Last Update Date | 2014-06-15 |