| NPI | 1467882845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 23100) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 18591) |
| Enumeration Date | 2013-11-20 |
| Last Update Date | 2014-01-20 |