| NPI | 1477087062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302035559) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 46827) |
| Enumeration Date | 2017-04-20 |
| Last Update Date | 2017-04-20 |