| NPI | 1487900841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 21684) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS022117) |
| 183500000X Pharmacist (Licence: PA RP031805L) | |
| 183500000X Pharmacist (Licence: IL 051.039492) | |
| Enumeration Date | 2012-08-02 |
| Last Update Date | 2017-10-06 |