| NPI | 1558731414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2008018182) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OK 13279) |
| Enumeration Date | 2015-10-03 |
| Last Update Date | 2015-10-03 |