| NPI | 1396126629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 23165) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD R178061) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2015-06-11 |