NPI | 1518381011 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302039986) |
Additional Taxonomies | 302R00000X Health Maintenance Organization (Licence: MI 5302039986) |
305S00000X Point of Service (Licence: MI 5302039986) | |
Enumeration Date | 2014-02-05 |
Last Update Date | 2014-02-05 |