| NPI | 1417365107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ S017703) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 17405) |
| 183500000X Pharmacist (Licence: CO 0020262) | |
| Enumeration Date | 2014-07-26 |
| Last Update Date | 2014-07-26 |