| NPI | 1427592153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 19536) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP0009865) |
| Enumeration Date | 2016-12-14 |
| Last Update Date | 2018-12-04 |