| NPI | 1467831156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR 0014867) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS54742) |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2016-07-25 |