| NPI | 1508282310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2008021312) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OK 14249) |
| 183500000X Pharmacist (Licence: KS 1-14812) | |
| Enumeration Date | 2014-03-17 |
| Last Update Date | 2014-03-17 |