| NPI | 1528471158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 016910) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302410916) |
| Enumeration Date | 2014-06-11 |
| Last Update Date | 2014-06-11 |