| NPI | 1558876953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: DC PH100001827) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 24598) |
| Enumeration Date | 2017-12-06 |
| Last Update Date | 2017-12-06 |