| NPI | 1487040374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP038969L) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS45795) |
| Enumeration Date | 2015-04-08 |
| Last Update Date | 2015-04-08 |