| NPI | 1558656470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CT PCT.0008812) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH24120) |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2011-06-20 |