| NPI | 1467705103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2012025445) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 7051839-1701) |
| Enumeration Date | 2012-10-18 |
| Last Update Date | 2012-10-18 |