| 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 |