| NPI | 1548696669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 22162) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 17213-40) |
| Enumeration Date | 2013-09-20 |
| Last Update Date | 2014-01-07 |