| NPI | 1497108625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 15937) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 12325) |
| Enumeration Date | 2016-07-23 |
| Last Update Date | 2016-07-23 |