| NPI | 1477952935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: LA 15510) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 33300) |
| Enumeration Date | 2014-08-20 |
| Last Update Date | 2014-08-20 |