| NPI | 1477918563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 55301051701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 55301058911) |
| Enumeration Date | 2015-12-16 |
| Last Update Date | 2015-12-16 |